Healthcare Provider Details

I. General information

NPI: 1134773401
Provider Name (Legal Business Name): VASCULAR SURGERY CLINIC OF AMCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 MYRTLE AVENUE 5TH FLOOR
ALBANY NY
12208
US

IV. Provider business mailing address

43 NEW SCOTLAND AVENUE MC-13
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5640
  • Fax: 518-262-5110
Mailing address:
  • Phone: 866-242-7476
  • Fax: 518-262-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. FRANCES S ALBERT
Title or Position: EVP, COO, CFO
Credential:
Phone: 518-262-3125